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Effectiveness of a Multifactorial Handwashing Program to Reduce School Absenteeism Due to Acute Gastroenteritis

Azor-Martínez, Ernestina MD, PhD*; Cobos-Carrascosa, Elena MD; Gimenez-Sanchez, Francisco MD, PhD; Martínez-López, Jose Miguel PhD; Garrido-Fernández, Pablo§; Santisteban-Martínez, Joaquin PhD; Seijas-Vazquez, Maria Luisa MD*; Campos-Fernandez, Maria Amparo MD*; Bonillo-Perales, Antonio MD, PhD

The Pediatric Infectious Disease Journal: February 2014 - Volume 33 - Issue 2 - p e34–e39
doi: 10.1097/INF.0000000000000040
Original Studies

Background: Acute gastroenteritis (AGE) is one of the most common diseases among children and an important cause of school absenteeism. The aim of this study was to assess the effectiveness of a handwashing program using hand sanitizers for the prevention of school absenteeism due to AGE

Methods: A randomized, controlled and open study of a sample of 1341 children between 4 and 12 years of age, attending 5 state schools in Almería (Spain), with an 8-month follow up (academic year). The experimental group (EG) washed their hands with soap and water, complementing this with the use of a hand sanitizer, and the control group (CG) followed the usual handwashing procedure. Absenteeism rates due GI were compared between the 2 groups through the multivariate Poisson regression analysis. Percent days absent in both groups were compared with a Z-test

Results: 446 cases of school absenteeism due to AGE were registered. The school children from the EG had a 36% lower risk of absenteeism due to AGE (IRR: 0.64, 95% confidence interval: 0.52–0.78) and a decrease in absenteeism of 0.13 episodes/child/academic year (0.27 of EG vs 0.40 CG/episodes/child/academic year, P < 0.001). Pupils missed 725 school days due to AGE and absent days was significantly lower in the EG (EG: 0.31%, 95% confidence interval: 0.28–0.35 vs. CG: 0.44%, 95% confidence interval: 0.40–0.48, P < 0.001)

Conclusions: The use of hand sanitizer as a complement to handwashing with soap is an efficient measure to reduce absent days and the number of school absenteeism cases due to AGE.

From the *Distrito Sanitario de Atención Primaria Almería; Servicio de Pediatría, Hospital Torrecárdenas; Universidad de Almería, Almería, España; §Statistician at Fundación para la Investigación Biosanitaria Andalucía Oriental Alejandro Otero (FIBAO), Hospital Torrecárdenas, Almería, España.

Accepted for publication August 21, 2013.

All phases of this study were supported by a grant from Department of Health of Andalusia (PI 0388/2008). The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Ernestina Azor-Martinez, MD, PhD, Paseo de los Sauces nº2 8ºD, Aguadulce 04720, Almería, Spain. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.